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Breast Cancer Risk Factors & Screening

Published: 10/09/2013

Family history of breast cancer puts a woman at increased risk for developing it. What does “family history” really mean?

“We primarily include first-degree relatives, which means sisters and mothers,” explains Dr. Lisa Jablon, director of the breast program at Einstein’s Marion Louise Saltzman Women's Center. “We also look at patterns of inheritance in grandmothers, aunts or multiple generations. Men can also transmit the genetic mutations, so we also look at the cancer history of the father’s family.”

Hereditary cancer is suspected if a family history includes women with bilateral breast cancer and those who developed it at a young age. “Under age 50 is important and under age 40 is of huge significance,” says Jablon. “The younger a woman is at the time of developing breast cancer, the more likely it is that genetic factors play a significant role.”

How does ovarian cancer factor into a family history?

It may be a sign of a hereditary cancer syndrome, Jablon explains. Any woman with a maternal or paternal family history of breast or ovarian cancer needs vigilant screening for both diseases. “A hereditary lineage of breast or ovarian cancer suggests a genetic component,” Jablon explains. “This is especially true in Ashkenazi Jewish families. They have a high incidence of the BRCA-1 and BRCA-2 genetic mutations. Ashkenazi Jews who have breast or ovarian cancer in their own medical history or in a first-degree relative may be candidates for genetic testing to determine if they carry the BRCA mutations.”

For more on genetic testing, read “BRCAs Decoded: Understanding Genetic Testing for Breast and Ovarian Cancer” with Dr. Adele Schneider, director of clinical genetics and medical director of the Victor Center for Jewish Genetic Diseases at Einstein Medical Center.

What are other risk factors for developing breast cancer?

Studies have shown that excessive alcohol consumption increases a woman’s risk of developing breast cancer, Jablon says. Significant research shows that treating postmenopausal women with hormone replacement in forms that contain estrogen and progestins puts them at risk, too. “There aren’t good studies about the use of so-called ‘natural’ hormones, but I would be wary of them, too,” Jablon says.

What kind of screening is appropriate for whom?

Jablon agrees with American Cancer Society guidelines that women over age 40 should receive annual mammograms. Women at increased risk for breast cancer should get two studies per year, one breast MRI and one standard mammogram – or, even better, a DBT mammogram.

Digital breast tomosynthesis (DBT) is a new technology that provides a 3-D rendering of breast tissue. Einstein Medical Center’s breast health experts participated in the clinical trials that proved DBT’s efficacy; it is now the mammogram recommended by Jablon and most other physicians.

“It’s a better test,” Jablon explains. “It is new technology and not yet available at all medical centers – but we have it here and it is available to our patients. I suggest that women ask their doctors about getting a DBT mammogram. If it is not available where they are, they should find a medical center that can provide it. The earlier we find an anomaly on a mammogram, the faster and better we can treat it.”